Assessment of changes in insulin requirement in patients of type 2 diabetes mellitus on maintenance hemodialysis.
Hemodialysis improves insulin sensitivity. Currently, there is no recommendation for the adjustment of insulin dose on dialysis day and nondialysis day in diabetic patients. This study was undertaken to determine the variations in insulin requirement based on blood glucose levels on dialysis days and nondialysis days in type 2 diabetic patients with chronic kidney disease on maintenance hemodialysis. Twenty-eight diabetic patients on hemodialysis were recruited into the study after obtaining written informed consent and approval from Azeezia Ethics Committee. Capillary blood glucose levels, just before dialysis and 2 h after dialysis, were checked and compared with fasting and postprandial glucose levels on-off dialysis days. Mean age of the patients was 59.5 (±2.3) years. The average duration of dialysis was 20.2 months. There was significant (35.8%) decrease in blood glucose levels 2 h after dialysis in comparison to predialysis levels (from mean level of 258-165 mg/dl). The decrease in the blood glucose levels from predialysis level to 2 h postdialysis level was statistically significant (P < 0.001). Both sets of data showed "strong" positive correlation with r = 0.657 and 0.849. The blood glucose levels on the day of dialysis were significantly lower than the off-day values. Diabetic patients with end-stage renal disease on hemodialysis have lower capillary blood glucose levels postdialysis. This has to be addressed clinically to prevent hypoglycemic episodes by reducing exogenous insulin administration on the day of dialysis.


[Cost differences in the treatment of severe sepsis between survivors and non-survivors on the first day of intensive care admission].
Patients admitted to intensive care unit with severe sepsis have high mortality and use significant resources. Determination of variable cost differences on day 1 between survivors and non-survivors of severe sepsis in Hungary. A sample of 6 intensive care units (ICU) included 70 patients who were admitted with severe sepsis to their ICU. Retrospective data collection of resource consumption for 24 hours following ICU admission using medical and nursing records. 59 different resource uses were collected separately for radiology, biochemistry and disposables. Blood products and drugs/fluids were collected individually. The authors identified the price of each resource for the cost calculation. The ICU mortality of severe sepsis in our sample was found to be 64%, the average length of stay for survivors was 19.9 (SD +/- 11.4) and for non-survivors was 13.0 (SD +/- 8.5). Mean ICU variable cost on day 1 of severe sepsis was HUF 60 957 (247 Euro), more for non-survivors (HUF 70 835 vs. 40 108, p = 0.020). The use of blood products is higher in non-survivors ( p = 0.047) and so is the use of drugs/fluids ( p = 0.003). The use of more colloids ( p = 0.016) and more expensive antibiotics ( p = 0.021) was responsible for the higher drugs/fluids spending in non-survivors. The mortality of severe sepsis is high and the cost of sepsis treatment is low in Hungary compared to international data. Non-survivors cost almost twice as much even on day 1, this warrants the need for early diagnosis and adequate treatment.


A State-of-the-Art Review of Organic Polymer Modifiers for Slope Eco-Engineering.
In slope ecological restoration projects, reinforcing soil and promoting vegetation growth are essential measures. Guest soil spraying technology can be used to backfill modified soil and vegetation seeds onto the slope surface, resulting in successful ecological restoration. The use of organic polymer modifiers to reinforce soil has several benefits, such as high strength, effective results, and low pollution levels. Organic polymer soil modifiers can be divided into two categories: synthetic polymer modifiers and biopolymer modifiers. This paper provides a thorough review of the properties and interaction mechanisms of two types of polymer modifiers in soil consolidation. The properties of organic polymer modifiers make them applicable in soil and vegetation engineering on slopes. These modifiers can enhance soil mechanics, infiltration, and erosion resistance and promote vegetation growth. Therefore, the suitability of organic polymer modifiers for soil and vegetation engineering on slopes is demonstrated by their properties and potential for improvement in key areas. Furthermore, challenges and future prospects for slope protection technology using organic polymer modifiers are suggested.


Clinical evaluation of a yeast recombinant hepatitis B vaccine in healthy hospital staff in Singapore.
A yeast recombinant hepatitis B vaccine (subtype adw), derived from purification of HBsAg particles, expressed in the yeast Saccharomyces cerevisiae which contained the gene for HBsAg, was evaluated in 31 healthy adult hospital staff members in Singapore. Each subject received a 10 mcg dose of vaccine intramuscularly at 0, 1 and 6 months. One month after the first two injections of vaccine the seroconversion rate (defined as greater than or equal to 2.7 mIU/ml) was 90%. Two months after the third injection 100% of participants had anti-HBs levels higher than 2.7 mIU/ml and 97% had titers of anti-HBs greater than 10 mIU/ml. The geometric mean titer (GMT) of anti-HBs levels at 2, 3, 6, 8 and 12 months were 21.9, 38.6, 57.6, 1253.4 and 354.1 mIU/ml, respectively. All clinical complaints were mild and transient. They consisted of mild soreness at the injection site, transient fever and headache. There was no correlation between the presence of antibodies to S. cerevisiae with any allergic manifestations. The vaccine was safe and immunogenic for staff exposed to an infection risk and should now be widely used in the extension of hepatitis B immunization programs.


Piperine from Black Pepper Decreased the Expression of Intercellular Adhesion Molecule-1 in Macrophages.
Macrophages are the main players involved in inflammation. Intercellular adhesion molecule-1 (ICAM-1) facilitates macrophage polarization prior to extravasation into inflamed tissue. Piperine, a natural product derived from black pepper, possesses useful biological and pharmacological activities. In the current study, the possible anti-inflammatory effect of piperine on the expression of ICAM-1 on J774.1 murine macrophage cell line was investigated. Lipopolysaccharide (LPS)-stimulated J774.1 cells were cultured in the presence of different concentrations of piperine to examine the changes in ICAM-1 expression by real-time PCR and flow cytometry. We found that piperine decreased ICAM-1 gene expression level from 2.4 ± 0.25 RFC (relative fold change) in LPS-only treated cells to 0.85 ± 0.525 RFC at 1µg/ml (p<0.05), 0.43 ± 0.27 RFC at 10µg/ml (p<0.01), and 0.26 ± 0.25 RFC at 20µg/ml (p<0.01). In flow cytometry, piperine at all concentrations significantly decreased ICAM-1 surface expressions (P<0.05). The geometric mean fluorescence intensity (g-MFI) in LPS-only treated cells (792 ± 57.3) decreased to 482±70 g-MFI at 20 μg/ml piperine. According to the results of this study, by decreasing the expression of ICAM-1, piperine has been suggested to reduce inflammation and have the potential to provide therapeutic benefits for immune-mediated diseases.


Titration of penicilloyl antibody by enzyme-immunoassay: method and data analysis to assign titer.
Antisera to the hapten, penicilloyl, were titered in an indirect enzyme immunoassay with the marker enzyme, horseradish peroxidase. A multivalent solid-phase antigen for stable solid-phase immunocomplex adsorption and a 10 min peroxidase light-assay with photolabile ortho-phenylenediamine were features of the assay. The penicilloyl antisera titration curves formed the basis for an evaluation of 4 methods to assign titer. Titer was expressed as either the antiserum dilution-1 that produced an assigned absorbance, exhibited 50% maximal antigen-antibody binding, and equaled zero absorbance by extrapolation, or as absorbance at 10(-3) antiserum dilution. The accuracy for extrapolated titer was improved with 2 or more solid-phase antigen concentrations. Absorbance at 10(-3) antiserum dilution was most useful as a screen for relative titer and for specific titer from a standard curve generated with many test sera. The antiserum dilution may vary with a particular enzyme immunoassay.


Raising Funds Through Social Media to Subsidise Cervical Cancer Screening with HPV Testing in Rural Ghana-The Battor Experience.
Over 260,000 women die yearly from cervical cancer, mostly in low and middle-income countries. Molecular testing for high-risk Human Papilloma Virus (HPV) is now the method of choice for cervical cancer screening. A limiting factor for HPV testing, however, is the cost in setting up and running the tests. Our objective was to reduce the cost of cervical cancer screening to rural folk by absorbing the initial cost of setting up. Crowdfunding was done through WhatsApp© and mobile money transfer. Individuals pledged amounts ranging from United States of America dollars ($) 2.6 to $3,769.2 (median = $25.6, Inter Quartile Range (IQR) = $12.8 to $38.5). Over four months $15,153 was raised to purchase the initial equipment for an HPV-based cervical cancer screening program. Crowdfunding is possible through a combination of WhatsApp© and mobile money transfer in low-resource settings. It obviates the need to organize gatherings requiring a budget and enables donors to become fundraisers.


Identification of sulfonyl-loxoprofen as novel phase 2 conjugate in rat.
Loxoprofen is a prodrug that exerts strong analgesic and anti-inflammatory effects through its active trans-alcohol metabolite, which is produced in the liver by carbonyl reductase. Previous metabolic studies have evaluated loxoprofen, but its sulfate and taurine conjugates have not yet been studied. We characterized the metabolomic profile of loxoprofen in rat plasma, urine, and feces using high-resolution mass spectrometry. We identified 17 metabolites of loxoprofen in the three different biological matrices, 13 of which were detected in plasma and feces and 16 in urine. Amongst these metabolites, two novel taurine conjugates (M12 and M13) and two novel acyl glucuronides (M14, M15) were identified for the first time in rats. In addition, we detected three novel sulfate conjugates (M9, M10, and M11) of loxoprofen. Further study of these metabolites of loxoprofen is essential in order to assess their potency and toxicity.


Organic-free synthesis of layer-like FAU-type zeolites.
The formation of layer-like FAU-type zeolites was facilitated in the absence of any organic template. Instead, the addition of simple inorganic salts turned out to be an effective and easy to handle alternative to organic additives to induce morphological and even structural changes during zeolite crystallisation.


Interphalangeal sesamoid bones of the great toe: an anatomic variant demanding careful scrutiny of radiographs.
We describe a patient who was found to have two sesamoid bones at the interphalangeal joint of the right great toe after radiographs for dislocation of the joint. Recognition of the sesamoids required careful scrutiny of the films. Interphalangeal sesamoids may cause painful callosities plantar to the joint or may become incarcerated in a dislocated joint. Our patient made a good recovery. The presence of sesamoid bones on the medial and lateral sides of the joint was unusual.


Mammographic calcification can predict outcome in women with breast cancer treated with breast-conserving surgery.
The impact of calcification in patients with breast carcinoma treated with breast-conserving surgery (BCS) is unclear. The present study aimed to determine the outcome of breast cancer patients with calcification treated with BCS. The records of 409 patients with breast carcinoma treated with BCS from January 2005 to December 2008 were reviewed. Patients were categorized as those with calcification (on mammography or ultrasonography), or those without calcification (neither on mammography nor ultrasonography). The local relapse free survival time (LRFS), disease free survival time (DFS) and overall survival time (OS) were compared, and subgroup analysis was performed based on morphological types and distribution patterns of mammographic calcification. Survival analysis demonstrated that patients with calcification had a significantly increased risk of local recurrence, distant metastasis and mortality compared with those without calcification [relative risk (RR) and 95% confidence interval (CI): local recurrence, 2.46 and 1.11-5.44; distant metastasis, 2.24 and 1.19-4.24; mortality, 2.50 and 1.06-5.86]. Subgroup analysis revealed that the distribution patterns (rather than morphological types of calcification) accounted for the increased risk of recurrence following BCS. Patients with mammographic calcification of liner/segmental distribution had significantly decreased LRFS (RR=6.20; 95% CI, 2.26-16.98), DFS (RR=6.81; 95% CI, 2.86-16.20) and OS (RR=9.14; 95% CI, 2.53-33.00), while patients with mammographic calcification of clustered distribution did not have significantly decreased LRFS, DFS and OS (P>0.05), compared with those without calcification. In addition, the mammographic calcification spreading along the ducts was more likely to be accompanied by an extensive intraductal component (P<0.001). Finally, the outcome of patients with calcification on breast ultrasound was as good as those without calcification. Patients with mammographic calcification, particularly those with calcification spreading along the ducts, have a higher risk of recurrence following BCS, which has a negative impact on long-term survival. Calcification identified on breast ultrasonography does not affect the survival of patients treated with BCS.


Diagnosis of Overtraining Syndrome: Results of the Endocrine and Metabolic Responses on Overtraining Syndrome Study: EROS-DIAGNOSIS.
Overtraining syndrome (OTS), a common dysfunction among elite athletes, causes decreased performance and fatigue and has no standardized diagnostic criteria. The Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) study identified more than 45 potential biomarkers of OTS. In the present study, we hypothesized that combinations of these biomarkers could be an accurate diagnostic tool for OTS. We selected parameters with largest difference and fewest overlapping results compared to healthy athletes and highest feasibility and reproducibility. Among the multiple combinations attempted, we chose those that did not show overlapping results, according to the objective. We included 11 clinical parameters, 4 basal hormones, and 5 hormonal responses in Insulin Tolerance Test (ITT). The three selected diagnostic tools were the (i) EROS-CLINICAL, with only clinical parameters, which was suitable as an initial assessment for athletes suspected of OTS; (ii) EROS-SIMPLIFIED, with clinical parameters and basal hormones, when the EROS-CLINICAL was inconclusive; and (iii) EROS-COMPLETE, with basal and hormonal responses to stimulation tests, which was valuable for population-based screening, research purposes, and unusual presentations of OTS. We identified innovative tools with 100% accuracy for the diagnosis of OTS, without the need to exclude confounding disorders.


Toll-like receptors and B-cell receptors synergize to induce immunoglobulin class-switch DNA recombination: relevance to microbial antibody responses.
Differentiation of naïve B cells, including immunoglobulin class-switch DNA recombination, is critical for the immune response and depends on the extensive integration of signals from the B-cell receptor (BCR), tumor necrosis factor (TNF) family members, Toll-like receptors (TLRs), and cytokine receptors. TLRs and BCR synergize to induce class-switch DNA recombination in T cell-dependent and T cell-independent antibody responses to microbial pathogens. BCR triggering together with simultaneous endosomal TLR engagement leads to enhanced B-cell differentiation and antibody responses. Te requirement of both BCR and TLR engagement would ensure appropriate antigen-specific activation in an infection. Co-stimulation of TLRs and BCR likely plays a significant role in anti-microbial antibody responses to contain pathogen loads until the T cell-dependent antibody responses peak. Furthermore, the temporal sequence of different signals is also critical for optimal B cell responses, as exemplified by the activation of B cells by initial TLR engagement, leading to the up-regulation of co-stimulatory CD80 and MCH-II receptors, which result in more efficient interactions with T cells, thereby enhancing the germinal center reaction and antibody affinity maturation. Overall, BCR and TLR stimulation and the integration with signals from the pathogen or immune cells and their products determine the ensuing B-cell antibody response.


[Effects of bisphosphonates on the mechanical efficiency of normal and osteopenic bones].
Bone mechanical competence (stiffness, strength) at organ level is determined by mechanical quality (intrinsic stiffness) and spatial distribution (macro-architecture) of bone material in cortical tissue (in every bone) and trabecular network (in vertebral bodies). These properties are inter-related and controlled according to mechanical usage by a feed-back mechanism known as mechanostat. Therefore, the effects on bone fragility of any treatment should be evaluated concerning the way they may have affected bone material or geometric properties as well as the mechanostatical interactions between them. Standard densitometry does not provide the necessary data, but some alternative methodologies (as peripheral quantitative computed tomography, pQCT) are being developed to complement or even substitute SPA, DPA or DXA determinations. Bisphosphonate (BP) effects on bone biomechanics have been studied only in animal models. Many sources of variation of results (type of compound, dose, mode of administration, species, race, sex, age, age since menopause, type of bone, remodeling ability of the skeleton, endocrine-metabolic status, interactions with other treatments, etc.) have been reported. In general terms, BPs are beneficial concerning cortical bone strength in purely modeling species (rodents) and trabecular strength in remodeling mammals (dogs, baboons). This positive action at organ level depends on independent improvements in bone macro-architecture (mainly affected by bone modeling) and material stiffness (chiefly affected by bone composition and remodeling). On one hand, bone macro-architecture has been positively affected by BPs in normal (not in ovariectomy (OX), steroid- or disuse-induced osteopenic) animals. On the other, bone material quality has been improved in the latter but not in the former. Mechanostatic interrelationships have been differently affected according to the compound employed. Results reported by ours and other laboratories concerning the three derivatives available nowadays in Argentina were reviewed and summarized. Pamidronate improved small rodents' cortical bone strength and geometric properties at low doses but impaired mineralization, material properties and strength at toxic doses. In normal, remodeling animals it improved mechanical properties in vertebral bodies but not in long bones. It also prevented the negative impact of OX-, steroid- or disuse-induced osteopenia in rats by improving bone material properties without affecting normal mechanostatic interrelationships. Olpadronate exerted positive effects on long-bone strength at any dose in normal rats and mice by improving cross-sectional properties and preserving both mineralization and material properties. These effects were highly dependent upon bone deformability, body weight, and mechanical usage of the limb as an evidence of an anabolic interaction induced on bone modeling and mechanostatic interrelationships. This compound also prevented the OX- or disuse-induced impairment in rat cortical long-bone strength and recovered rat cortical bone when given since 3 months after OX by improving only bone material quality. No interaction with bone mechanostat was detected in these studies. Alendronate effects on bone biomechanics in normal rats and dogs were positive only in long treatments. They were highly dependent on body weight of the animals, hence a positive interaction with bone mechanostat should be hypothesized. It also prevented the negative impact of OX in rat femurs by improving cortical material quality with no effect on cross-sectional properties, i.e., exerting an anti-catabolic interaction with bone mechanostat. The effects of all the three compounds were found positive for bone health, yet their mechanisms of action varied with type of bone and subject condition. A striking dissociation between (positive) effects on bone strength and (variable) effects on bone stiffness was repeatedly observed in these studies. Also an enla


[Retrieval of spectral characteristics of hyperspectral sensor and retrieval of reflectance spectra].
On-orbit spectral calibration of hyperspectral imaging data is a key step for quantitatively analyzing them. Like the atmospheric correction, accurate spectral calibration is very necessary for improved studies of land or ocean surface properties. Based on the previous literatures, a new method which coupled an optimization algorithm was developed to simultaneously retrieve the central wavelength and the full width at half maximum (FWHM) of the hyperspectral sensor without needing the in situ reflectance spectra. Firstly, the Hyperion data set simulated using MODTRAN4 with the Hyperion spectral specification was used to test the new method, and the results indicated that the maximum error was less than 0.1 and 0.7 nm for central wavelength and FWHM respectively when the spectral shift is 5 nm. Then the algorithm was applied to the Hyperion data acquired on May 20, 2008 over Heihe River Basin and it was iteratively performed for each detector of the two spectrometers of Hyperion. The results showed that the VNIR of Hyperion had a pronounced smile effect, and the shift in on-orbit calibration with respect to the laboratory was from -2 to +2 nm, while the SWIR has essentially no smile effect, the wavelength correction was relatively flat over all sample with an approximately constant value of 3 nm. The FWHM in VNIR could range from -0.2 to 0.5 nm as a function of sample number of the spectrometer, and in SWIR it ranged from -2 to -3 nm. So for both the VNIR and SWIR, the original spectral calibration should be updated. These results showed good agreement with previous research findings, and which also proved the feasibility of the new method. Finally, with the updated spectral calibration characteristics, the sample reflectances of desert and vegetation target in our study site were reconstructed by applying a further atmospheric correction, and as expected, the strong spikes around the typical atmospheric absorption were almost disappeared.


Effect of kuratsuki Kocuria on sake brewing in different koji conditions.
Koji is made using steamed rice and a koji mold, which plays an essential role in sake brewing. We challenge to build a new sake brewing method using the kuratsuki bacteria that have inhabited each sake brewery. In this paper, effects of the kuratsuki Kocuria strain TGY1127_2 were estimated on sake brewing in different koji conditions. Sake was produced by incubation of a mixture solution of koji, water, and sake yeast (strain K1401) with and without the kuratsuki Kocuria TGY1127_2. The effects of the kuratsuki Kocuria on the taste of the sake differed among different koji. The kuratsuki Kocuria led to an increase in ethanol concentration. Additionally, the sugar content (Brix) and acidity of the sake increased in proportion to the amount of koji. These results strongly suggest that the kuratsuki Kocuria does not adversely affect the fermentation activity of the sake yeast. Thus, the kuratsuki Kocuria had different effects on the taste of sake among different koji but the fermentation activity of the sake yeast was maintained.


Erythropoietin and sildenafil protect against ischemia/reperfusion injury following testicular torsion in adult rats.
Testicular torsion/detorsion causes severe tissue damage due to ischemia/reperfusion injury. The present study investigated the protective effect of erythropoietin and sildenafil against ischemia/reperfusion injury following unilateral testicular torsion/detorsion in adult rats. A total of 28 adult male rats were included, and were divided into the following groups: Group A (n=5), sham operated; groups B (n=5), C (n=5), D (n=5) and E (n=8), undergoing right testis torsion and detorsion after 90 min. Group B received no drug treatment. Rats in the groups C and D received low-dose (1,000 IU/kg) or high-dose (3,000 IU/kg) erythropoietin, while those in group E received sildenafil (0.7 mg/kg), through intraperitoneal injection after 60 min of torsion. The right testis was extracted 24 h after detorsion, and the tissue was subjected to histopathological examination and immunohistochemical assessment of cleaved caspase-3 expression. Histological alterations and the quality of spermatogenesis were scored according to the Cosentino and the Johnsen scoring systems, respectively. The results demonstrated normal testicular architecture in group A, while the other groups showed ischemic cellular damages, with the worst scores observed in group B. Groups D and E presented better scores compared with group C. Regarding the quality of spermatogenesis, the best scores were observed in group A, and the worst in group B. Groups C, D and E presented similar results, which were improved in comparison to group B, however, not compared to group A. Furthermore, cleaved caspase-3 levels were lower in groups A, D and E, with equal results observed. Group C had higher levels of cleaved caspase-3 compared with these groups, but lower than group B, which presented the highest cleaved caspase-3 levels. In conclusion, erythropoietin and sildenafil protect testis from ischemia/reperfusion injury by decreasing cellular damage and attenuating apoptosis.


Thermo-active elastomer composite for optical heating in microfluidic systems.
Single-walled carbon nanotubes are used as doping agents to form thermo-active composites with an elastomeric block-copolymer. Thermal imaging reveals that the temperature response upon irradiation with NIR laser light is dependent (among other things) on the mass fraction of the nanotubes in the polymer matrix.


Frequency, Indications And Complications Of Pulmonary Artery Catheter Insertion In Adult Open-Heart Surgery Patients Of A Tertiary Care Hospital.
Patients presenting for cardiac surgery have unstable cardiovascular disease and haemodynamics with multiple coexisting diseases. Optimal monitoring in the perioperative period is very important for best perioperative outcome. The introduction of the flow-directed pulmonary artery catheter (PAC) into clinical practice is one of the most important and popular advances in the field of cardiac anaesthesia. The objective of the study was to determine the frequency, indications and complications of pulmonary artery catheter insertion in adult open-heart surgery patients. A Prospective observational study was conducted at cardiac operating rooms and Cardiac Intensive care unit (CICU) of Aga Khan University Hospital for a period of six months from Nov 2015 to April 2016.Two hundred and seven patients were included in this study. PAC was inserted through right/left internal jugular vein or subclavian vein. Complications noted were arrhythmias (atrial and ventricular), right bundle branch block, coiling and knotting, pulmonary artery rupture, and infection up to 72 hours of PAC insertion. Frequency and percentage were computed for gender, comorbids (Hypertension, Diabetes, Chronic kidney disease, Chronic Obstructive Pulmonary Disease) and PAC frequency of insertion, indications and complications were noted. The frequency of PAC insertion was 47.83%. Major indications for PAC insertion were poor left ventricular function, acute coronary syndrome, cardiogenic shock, significant left main disease and valvular heart disease patients. Minor complications were found in 23.22% cases, which included arrhythmia in 19.2% cases and coiling in 4.02%. TPulmonary artery catheter insertion is a safe technique with useful clinical application in the management of high-risk cardiac surgical patients. The PAC insertion rationale must be standardized to confirm the judicious use.


Oxidative stress in Graves' disease patients and antioxidant protection against lymphocytes DNA damage in vitro.
DNA damage to peripheral blood lymphocytes of patients with Graves' disease (GD) was studied in vitro before and after treatment with antioxidants, melatonin, quercetin, N-acetylcysteine (NAC) and vitamin C. DNA damage (comet %) was remarkably higher in patients (23.7 +/- 5.5%) than that in healthy persons (9.8 +/- 3.2%, p < 0.01). Plasma malondialdehyde (MDA) content (7.90 +/- 1.77 microM) of patients was significantly higher than that of healthy persons (4.71 +/- 1.19 microM, p < 0.01). Also, the plasma total antioxidant capacity (TAC) (7.53 +/- 1.35 U/ml) in GD patients was significantly lower than that in healthy persons (10.56 +/- 2.21 U/ml, p < 0.01). Negative correlations were observed between plasma TAC and DNA damage in lymphocytes (r = -0.599, p < 0.01), and between plasma TAC and MDA (r = -0.40, p < 0.05) in GD patients. After treatment with 100 microM melatonin, quercetin or NAC for 4 h in vitro, DNA damage in lymphocytes in GD patients declined significantly (from 23.8 +/- 4.4% to 14.4 +/- 4.0%, p < 0.001 for melatonin, from 23.4 +/- 4.7% to 18.1 +/- 4.3%, p < 0.01 for quercetin, from 23.7 +/- 4.0% to 18.7 +/- 5.7%, p < 0.05 for NAC), while there was little change with concentrations of 1-100 microM of vitamin C. However, 1000 microM vitamin C enhanced DNA damage significantly (from 23.8 +/- 2.3% to 30.3 +/- 3.9%, p < 0.05). Our results showed that oxidative stress existed in GD patients and the antioxidants melatonin, quercetin and NAC are beneficial for DNA damage in lymphocytes of GD patients in vitro.


Ki-67 antigen expression in the mammary epithelium of female rats in persistent estrus treated with anastrozole.
To evaluate Ki-67 antigen expression in mammary epithelium of female rats in persistent estrus treated with anastrozole. Twenty-eight Wistar-Hanover female rats in persistent estrus induced by subcutaneous injection of 1.25 mg of testosterone propionate in the second day of life were randomly divided into two groups, control and experimental, with 14 animals each. The animals of control group received only the vehicle (propyleneglycol) and the animals of group experimental received 0.125 mg daily of anastrozole by gavage during 28 days. After 28 days of treatment, all animals were sacrificed and the first pair of abdominal-inguinal mammary glands was removed and fixed in 10% buffered formalin to investigate Ki-67 antigen expression by immunohistochemistry. The mean percentage of Ki-67-stained nuclei per 500 cells in the mammary epithelium was 76.97 ± 0.76 and 14.44 ± 2.02 [mean ± standard error of the mean (SEM)] in the control and experimental groups, respectively (p < 0.0001). Anastrozole treatment significantly reduced Ki-67 expression in the mammary epithelium of rats in persistent estrus.


Phase synchronization of inhibitory bursting neurons induced by distributed time delays in chemical coupling.
Considering the fact that signal transmission time delays between different pairs of synaptically coupled neurons in the brain are different, we study the effects of distributed time delays on phase synchronization of bursting neurons. We consider the case of inhibitory coupled bursting Hindmarsh-Rose neurons and find that distributed time delays in chemical coupling can induce a variety of phase-coherent dynamic behaviors. The critical mean time delay for the emergence of coherent behaviors is inversely proportional to both the coupling strength and the average degree. This phenomenon is robust to nonidentical external inputs and is independent of network topology. A physical theory is formulated to explain the emergence of coherent neuronal activity.


Effect of through-space electron transfer on infrared spectrum of amorphous selenium.
In this paper we present theoretical analyses on an infrared (IR) spectrum of amorphous selenium. The system is described by a 216-atom-chain model, and a set of molecular-dynamics simulations is performed to generate vitreous structures and vibrational modes. To describe an electronic structure of the system we employ a complete neglect of differential overlap model parametrized by ab initio cluster calculations. An IR intensity is evaluated with the Berry-phase formula for an electronic polarization. The effect of the through-space electron transfer on the IR spectrum is studied by artificially changing the magnitude of matrix elements associated with the electron transfer between nonbonded atoms in the chain. We find that the through-space electron transfer leads to (i) the enhancement of the bending IR peak at 135 cm(-1) and (ii) the appearance of a new low-frequency peak around 50 cm(-1), thus resulting in a good agreement with the experiment. The mechanism is discussed by a simple dipole model.


Photoluminescence study of time- and spatial-dependent light induced trap de-activation in CH3NH3PbI3 perovskite films.
Organometal halide perovskite-based solar cells have rapidly achieved high efficiency in recent years. However, many fundamental recombination mechanisms underlying the excellent performance are still not well understood. Here we apply confocal photoluminescence microscopy to investigate the time and spatial characteristics of light-induced trap de-activation in CH3NH3PbI3 perovskite films. Trap de-activation is characterized by a dramatic increase in PL emission during continuous laser illumination accompanied by a lateral expansion of the PL enhancement far beyond the laser spot. These observations are attributed to an oxygen-assisted trap de-activation process associated with carrier diffusion. To model this effect, we add a trap de-activation term to the standard semiconductor carrier recombination and diffusion models. With this approach we are able to reproduce the observed temporal and spatial dependence of laser induced PL enhancement using realistic physical parameters. Furthermore, we experimentally investigate the role of trap diffusion in this process, and demonstrate that the trap de-activation is not permanent, with the traps appearing again once the illumination is turned off. This study provides new insights into recombination and trap dynamics in perovskite films that could offer a better understanding of perovskite solar cell performance.


Morphology and Structure Engineering in Nanofiber Reactor: Tubular Hierarchical Integrated Networks Composed of Dual Phase Octahedral CoMn2 O4 /Carbon Nanofibers for Water Oxidation.
1D hollow nanostructures combine the advantages of enhanced surface-to-volume ratio, short transport lengths, and efficient 1D electron transport, which can provide more design ideas for the preparation of highly active oxygen evolution (OER) electrocatalysts. A unique architecture of dual-phase octahedral CoMn2 O4 /carbon hollow nanofibers has been prepared via a two-step heat-treatment process including preoxidation treatment and Ostwald ripening process. The hollow and porous structures provide interior void spaces, large exposed surfaces, and high contact areas between the nanofibers and electrolyte and the morphology can be engineered by adjusting the heating conditions. Due to the intimate electrical and chemical coupling between the oxide nanocrystals and integrated carbon, the dual-phase octahedral CoMn2 O4 /carbon hollow nanofibers exhibit excellent OER activity with overpotentials of 337 mV at current density of 10 mA cm-2 and Tafel slope of 82 mV dec-1 . This approach will lead to the new perception of design issue for the nanoarchitecture with fine morphology, structures, and excellent electrocatalytic activity.


Nanostructured Light-Emitting Polymer Thin Films and Devices Fabricated by the Environment-Friendly Push-Coating Technique.
Push-coating is a green and extremely low-cost process in which only few microliters of conjugated polymer solutions are used to produce thin films using capillary forces. Here, we adapt this fabrication technique to replicate self-assembled nanoporous structures on green and red light-emitting conjugated polymer thin films. These films display ring-like photoluminescence and are successfully integrated into polymer light-emitting devices as emitting layers. At low applied voltages, the green-emitting devices exhibit electroluminescence (EL) from hexagonally arranged nanopixel arrays resulting from a stronger electric field in the thinner areas inside the pores. By gradually increasing the voltage up to 10 V, the emission extends to the areas around the pores. At voltages higher than 10 V, a nonreversible nanopixel to nanoring-like switching of the EL can be observed. After filling the pores with a second blue-emitting conjugated polymer, voltage-dependent reversible color tuning of the EL is achieved in the nanostructured light-emitting bilayers.


The usefulness of D-dimer in diagnosis and prediction of venous thromboembolism in patients with abdominal malignancy.
of the study was to evaluate the usefulness of D-dimer evaluation in the diagnosis and prediction of venous thromboembolism (VTE) of lower extremities in patients operated on for abdominal tumors depending on the chosen cut-off point for this parameter. We included 150 patients operated on for abdominal cancer in our department between October 2014 and June 2016. In these patients, concentration of D-dimer was determined, medical histories were taken, and physical examinations were performed. Ultrasound exams of the veins of the lower limbs were performed three times in every patient in order to confirm or exclude VTE. When a standard cut-off point (500 ng/ml) was used, in 46% of cancer patients D-dimer values were elevated despite the lack of VTE. We did not detect any influence of cancer stage on the value of D-dimer. However, if cut-off point was 1440 ng/ml, which has been suggested in the literature, only 14% of patients were false positive. When the upper cut-off value for D-dimer was raised, the effect of cancer stage on the value of this parameter could be seen. The concentration of D-dimer is often elevated in patients with active cancer, but is not a sufficient criterion for diagnosis of VTE. The concentration of D-dimer before surgery does not determine the risk of postoperative thromboembolic complications. This is undoubtedly related to the widespread use of effective thromboprophylaxis. According to the literature, ultrasound is the optimum method for detection of VTE in surgically treated cancer patients. The effect of cancer stage on the value of D-dimer is revealed only when the cut-off point in this group is 1440 ng/ml, instead of 500 ng/ml which is used for the general population.


A single-center 7-year experience with end-stage renal disease care in Nigeria-a surrogate for the poor state of ESRD care in Nigeria and other sub-saharan african countries: advocacy for a global fund for ESRD care program in sub-saharan african countries.
Background. A single-center ESRD care experience in a Nigerian teaching hospital is presented as a surrogate case to demonstrate the prevailing ESRD care situation in Nigeria and most SSA countries. Methods. The data of 320 consecutive ESRD patients undergoing maintenance haemodialysis treatment during a seven-year period were retrospectively analyzed. Results. Over 80% of the subjects funded dialysis treatments from direct out of pocket payment. The mean duration on dialysis before dropout was 5.2 ± 7.6 weeks, with majority 314 (98.1%) of the patients unable to sustain dialysis above 12 weeks. Total dialysis sessions during the 7-year period was 1476 giving an average weekly dialysis session of 0.013 (0.05 hour/week) per patient per week. One hundred and twenty-eight (40%) patients died within 90 days of entry into dialysis care. Conclusions. ESRD care in this single centre was characterized by gross dialysis inadequacy and case fatality due to the inability to access and afford care. The opportunities for kidney transplantation are also very low. Poverty and the absence of government support for ESRD care are responsible for the poor outcomes. A global focus on ESRD care in SSA countries has thus become imperative.


Hematopoietic cell transplantation for mantle cell lymphoma: predictive value of pretransplant positron emission tomography/computed tomography and bone marrow evaluations for outcomes.
The prognostic roles of 18F-fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging and marrow involvement evaluation on outcomes following autologous and allogeneic hematopoietic cell transplantation (HCT) for mantle cell lymphoma (MCL) are uncertain and require more data. We categorized 66 patients with MCL who received HCT (38 autologous and 28 allogeneic) on the basis of pre-HCT residual disease (RD) status as assessed by marrow MCL morphology and flow/molecular analysis and PET/CT imaging to RD positive (RD(+)) (either or both measures positive) and RD(-) (both negative). We analyzed the predictive value of these RD detection methods on transplant outcomes. The 2-year relapse rate after autograft was significantly higher in pre-HCT RD(+) patients (46% [95% CI 16-77%]) than in patients who were RD(-) (19% [95% CI 0-42%]; P = .02), leading to worse 5-year disease-free survival (DFS) in RD(+) patients (46% [95% CI 14%-73%] vs. 68% [95% CI 33-87%], P = .04). In multivariate analysis, RD(+) status was associated with a reduction in DFS (hazard ratio, 5.6; P = .02). Most allogeneic HCT recipients had advanced disease and most were RD(+) (12 PET/CT(+); 5 marrow-positive). The 5-year DFS and relapse rates after allogeneic HCT were 34% and 25% for all patients and 40% and 33% for RD(+) recipients, suggesting that active disease at the time of allograft does not preclude long-term remissions in advanced MCL. Both autologous and allogeneic HCT lead to promising long-term survival. RD detected prior to autograft was associated with increased relapse and worse 5 year DFS. Allograft recipients had favorable long-term outcomes even in presence of pre-HCT detectable disease.


[The surgical management of blunt liver trauma].
One hundred and sixty-six consecutive patients with closed hepatic injury admitted to Osaka University Hospital from 1966 to 1990 were reviewed to evaluate the surgical procedures for injured liver. Of the 166 patients, 37 died within 24 hours of initial management. Thirteen (35%) of the 37 died related to exsanguinating hemorrhage of liver injury. Emergency laparotomy required hepatic resection in all and revealed hepatic vein or retrohepatic caval injuries in 9. Eighty-nine of 129 patients who survived over 24 hours of initial management underwent emergency laparotomy. Twenty-two of the 129 died thereafter. Five (3 underwent lobectomy and 2 simple suture) died of liver injury-related complications. Perihepatic packing was performed in 5 and all except for 2 of brain death were alive. Most complications except for hemobilia were well resolved. CT scan study revealed profoundly radiating injuries closed to spine in 63% and suggested existence of hepatic vein or caval injury. Especially, 20 of 31 CT studies (65%) in conservative management of liver injury showed the same findings with intact capsule. These results support that exsanguinating hemorrhage from deep injury including hepatic vein or vena cava is the most lethal but can be controlled with liver packing in a similar mechanism to liver trauma in conservative management.


[Seishin-renshi-in therapy for patients with discomforts on the lower urinary tract].
The clinical effect of Seishin-renshi-in was studied in 18 patients with prolonged discomfort in the lower urinary tract. Seishin-renshi-in was administered orally at doses of 7.5 g, for courses ranging from 2 weeks to more than 10 weeks. Except in 4 cases in which administration was stopped because of slight side effects on the gastrointestinal tract; the overall effective ratio was 81%. Our findings suggest that Seishin-renshi-in may be useful in the control of discomforts in the lower urinary tract.


Effectiveness of therapeutic anticoccidial drugs against recently isolated coccidia.
Litter samples were collected weekly from 17 broiler houses and coccidial oocysts were counted. Oocysts per gram were low on the Weeks 1 and 2 of the growout, increased to a peak on the Week 4, then declined to near zero on Weeks 6 and 7. Coccidia from each house were propagated and tested for sensitivity to therapeutic formulations of amprolium, sulfaquinoxaline, and sulfaquinoxaline plus pyrimethamine. The degree of control was based on the weight gains and lesion scores of the medicated groups in comparison with those of the unmedicated, infected, and uninfected groups. The predominant species found in the 17 isolates were Eimeria tenella and E. acervulina. Amprolium was effective against E. tenella in all isolates but only partly effective against E. acervulina. Sulfaquinoxaline and the potentiated mixture were effective against the E. acervulina but only partly effective against the E. tenella. The potentiated mixture was better against E. tenella than sulfaquinoxaline alone.


Monitoring the Size and Metabolic Activity of the Bacterial Community during Biostimulation of Fuel-Contaminated Soil using Competitive PCR and RT-PCR.
Efforts to understand and improve soil bioremediation are limited by our ability to determine how treatment variables affect microbial communities. A method was developed to monitor the density and metabolic activity of the total bacterial community in soil. This method was used to monitor the bacterial community in microcosms of Arctic soil after addition of N plus P to stimulate biodegradation of hydrocarbon contaminants. During 29 days of incubation, the total petroleum hydrocarbon level in the soil was reduced from 850 to 360 mg/g of soil. DNA and RNA were extracted from soil using a bead beating method, purified by ammonium acetate precipitation, and assayed by competitive PCR and RT-PCR assays with universal bacterial primers. The copy number of 16S rDNA in the soil microbial community was relatively stable and ranged from 1.7 x 109 to 4.5 x 109/g of soil throughout the incubation. The copy number of 16S rRNA changed substantially and ranged from 5.6 x 1010 to 1.0 x 1012/g of soil. The rRNA:rDNA ratio was highest during the phase of fastest hydrocarbon biodegradation. These results suggest that the treatment to stimulate hydrocarbon biodegradation did not substantially change the density of the bacterial community but did transiently increase its overall metabolic activity.


The antidepressant sertraline inhibits translation initiation by curtailing mammalian target of rapamycin signaling.
Sertraline, a selective serotonin reuptake inhibitor, is a widely used antidepressant agent. Here, we show that sertraline also exhibits antiproliferative activity. Exposure to sertraline leads to a concentration-dependent decrease in protein synthesis. Moreover, polysome profile analysis of sertraline-treated cells shows a reduction in polysome content and a concomitant increase in 80S ribosomes. The inhibition in translation caused by sertraline is associated with decreased levels of the eukaryotic initiation factor (eIF) 4F complex, altered localization of eIF4E, and increased eIF2alpha phosphorylation. The latter event leads to increased REDD1 expression, which in turn impinges on the mammalian target of rapamycin (mTOR) pathway by affecting TSC1/2 signaling. Sertraline also independently targets the mTOR signaling pathway downstream of Rheb. In the Emu-myc murine lymphoma model where carcinogenesis is driven by phosphatase and tensin homologue (PTEN) inactivation, sertraline is able to enhance chemosensitivity to doxorubicin. Our results indicate that sertraline exerts antiproliferative activity by targeting the mTOR signaling pathway in a REDD1-dependent manner.


Hopelessness and attempted suicide: a reconsideration.
The authors administered measures of depression, hopelessness, and strength of suicidal intent to a sample of 112 suicide attempters. The results for the 55 subjects diagnosed as depressive and admitted within 72 hours after their attempt were compared with results obtained by Minkoff and associates using comparable measures. Contrary to the findings of the earlier study, there was a lower correlation between hopelessness and intent than between depression and intent. The authors suggest that demographic differences between the two samples may provide explanations for this descrepancy, in the that they reflect the presence or absence of external societal supports that may influence the suicidogenic potential of hopelessness.


Inertial Sensors for Performance Analysis in Combat Sports: A Systematic Review.
The integration of technology into training and competition sport settings is becoming more commonplace. Inertial sensors are one technology being used for performance monitoring. Within combat sports, there is an emerging trend to use this type of technology; however, the use and selection of this technology for combat sports has not been reviewed. To address this gap, a systematic literature review for combat sport athlete performance analysis was conducted. A total of 36 records were included for review, demonstrating that inertial measurements were predominately used for measuring strike quality. The methodology for both selecting and implementing technology appeared ad-hoc, with no guidelines for appropriately analysing the results. This review summarises a framework of best practice for selecting and implementing inertial sensor technology for evaluating combat sport performance. It is envisaged that this review will act as a guide for future research into applying technology to combat sport.


Treatment comparison in randomized clinical trials with nonignorable missingness: A reverse regression approach.
A common problem in randomized clinical trials is nonignorable missingness, namely that the clinical outcome(s) of interest can be missing in a way that is not fully explained by the observed quantities. This happens when the continued participation of patients depends on the current outcome after adjusting for the observed history. Standard methods for handling nonignorable missingness typically require specification of the response mechanism, which can be difficult in practice. This article proposes a reverse regression approach that does not require a model for the response mechanism. Instead, the proposed approach relies on the assumption that missingness is independent of treatment assignment upon conditioning on the relevant outcome(s). This conditional independence assumption is motivated by the observation that, when patients are effectively masked to the assigned treatment, their decision to either stay in the trial or drop out cannot depend on the assigned treatment directly. Under this assumption, one can estimate parameters in the reverse regression model, test for the presence of a treatment effect, and in some cases estimate the outcome distributions. The methodology can be extended to longitudinal outcomes under natural conditions. The proposed approach is illustrated with real data from a cardiovascular study.


[Spontaneous intracranial hypotension with severe headache and typical neuroradiological findings: report of two cases].
Intracranial hypotension causes the postural headache that sometimes follows lumbar puncture. When postural headache and associated symptoms occur after lumbar puncture, the diagnosis is usually obvious. However, similar symptoms may occur after minor trauma or without an obvious precipitating cause (spontaneous intracranial hypotension: SIH). SIH is rare, but is now increasingly recognized as a cause of postural headache. We encountered two cases of SIH showing typical neuroradiological findings. Case 1 is a 47-year-old man who was admitted with severe frontalgia. CT scan revealed vague visualization of bilateral Sylvian fissures and slit ventricles. Spinal fluid pressure was 6cm H2O in the lateral recumbent position. Cerebrospinal fluid (CSF) showed slight lymphocytic pleocytosis. We treated him as having viral meningitis. His headache improved gradually and he was discharged 2 weeks later with slight occipitalgia. One week after discharge, he complained of severe headache again and plain CT showed bilateral subdural hematoma. The subdural hematoma in both sides was evacuated and his headache improved after the operation. Follow-up CT scans two months later showed normalization of ventricle size and cisterns. Case 2 is a 52-year-old woman who was admitted with severe occipitalgia. CT scan on admission showed slit ventricles and the disappearance of the suprasellar cistern and the Sylvian fissure. Spinal fluid pressure was 3cm H2O. Gd-enhanced MRI showed remarkable meningeal enhancement and effacement of the optic chiasm suggesting brain sagging. Her headache improved 2 weeks later after strict bed rest and oral pain relief drugs. The follow-up MRI showed disappearance of abnormal meningeal enhancement and normalization of optic chiasma effacement. SIH is one of the important differential diagnoses of patients complaining of postural headache. Meningeal enhancement of gadolinium-enhanced MRI is an important finding to diagnose SIH. We have to consider SIH when diagnosing postural headache.


Twenty-four-hour non-invasive monitoring of systemic haemodynamics and cerebral blood flow velocity in healthy humans.
Acute short-term changes in blood pressure (BP) and cardiac output (CO) affect cerebral blood flow (CBF) in healthy subjects. As yet, however, we do not know how spontaneous fluctuations in BP and CO influence cerebral circulation throughout 24 h. We performed simultaneous monitoring of BP, systemic haemodynamic parameters and blood flow velocity in the middle cerebral artery (MCAV) in seven healthy subjects during a 24-h period. Finger BP was recorded continuously during 24 h by Portapres and bilateral MCAV was measured by transcranial Doppler (TCD) during the first 15 min of every hour. The subjects remained supine during TCD recordings and during the night, otherwise they were seated upright in bed. Stroke volume (SV), CO and total peripheral resistance (TPR) were determined by Modelflow analysis. The 15 min mean value of each parameter was assumed to represent the mean of the corresponding hour. There were no significant differences between right vs. left, nor between mean daytime vs. night time MCAV. Intrasubject comparison of the twenty-four 15-min MCAV recordings showed marked variations (P < 0.001). Within each single 15-min recording period, however, MCAV was stable whereas BP showed significant short-term variations (P < 0.01). A day-night difference in BP was only observed when daytime BP was evaluated from recordings in the seated position (P < 0.02), not in supine recordings. Throughout 24 h, MCAV was associated with SV and CO (P < 0.001), to a lesser extent with mean arterial pressure (MAP; P < 0.005), not with heart rate (HR) or TPR. These results indicate that in healthy subjects MCAV remains stable when measured under constant supine conditions but shows significant variations throughout 24 h because of activity. Moreover, changes in SV and CO, and to a lesser extent BP variations, affect MCAV throughout 24 h.


[Velo-palatoplasty. Surgical treatment of upper respiratory tract obstruction in children].
The surgical treatment of primary obstructive sleep apnea syndrome (OSAS) in childhood still remains relatively unknown. The Uvulo-Palato-Pharyngo-Plasty regularly performed in adults cannot be used for children. This technique jeopardizes phonation and swallowing. We are reporting data concerning a retrospective study about twenty-one infants suffering from a primary obstructive sleep apnea syndrome. Their mean age was three years and four months. Eighteen patients were operated by means of a new technic which has been developed and has been developed ans used since 1982: after adjusted Palato-Vomeral resections Velo-Palato-Plasty brings an advancement of the velum thus entailing the upper airway's widening. Velo-Palato-Plasty can be performed without any risks from the very first years in childhood. A follow-up study of six years shows sixteen good results. In two cases, obstruction and apnea remained because of a general evolutive affection which contraindicates this procedure of surgery.


A variant branch of the internal laryngeal nerve supplying filaments to the cricothyroid muscle: an autopsy case.
We report a variant branch of the internal laryngeal nerve found in a Japanese male body. This branch, arising in the piriform fossa from the inferior portion of the loose network formed by the intercommunicating subbranches of the internal laryngeal nerve, descended in the interval between the thyroid and arytenoid cartilages accompanied by a branch of the superior laryngeal artery as far downward as the lowest portion of the thyroid cartilage. Here it crossed lateral to the inferior laryngeal nerve to which it gave off a communicating branch and reached the deep surface of the cricothyroid muscle. In this muscle it split into several divisions, each of which issued filaments to this muscle. The terminal branch of this variant branch ended in the fascia covering the cricothyroid muscle and the cricoid cartilage.


Cutaneous reactions to drugs in children.
Cutaneous eruptions are a commonly reported adverse drug reaction. Cutaneous adverse drug reactions in the pediatric population have a significant impact on patients' current and future care options. A patient's recollection of having a "rash" when they took a medication as a child is a frequent reason for not prescribing a particular treatment. The quick detection and treatment of cutaneous adverse drug reactions, plus identification of the causative agent, are essential for preventing the progression of the reaction, preventing additional exposures, and ensuring the appropriate use of medications for both the current condition and others as the patient ages. The purpose of this review is to discuss a reasonable approach to recognition and initial management of cutaneous adverse drug reactions in children.


Suture needle drainage of subretinal fluid.
A simple technique is described for the transcleral drainage of subretinal fluid during retinal detachment repair. In a prospective study of 94 consecutive suture needle drainage procedures subretinal fluid was successfully drained in 91 cases. There were six 'significant' subretinal haemorrhages associated with the procedure, but none was subfoveal in location or directly compromised the surgical outcome. In no case was retinal incarceration or retinotomy observed.


The Ly-49 family: regulation of cytotoxicity and cytokine production in murine CD3+ cells.
The Ly-49 gene families are class I-recognizing receptors on murine NK cells. Most Ly-49 receptors inhibit NK cell lysis upon recognizing their target class I ligands. In this report we have examined the ability of Ly-49A and Ly-49G2 to regulate T cell functions on CD3+ cells, primarily the subset that also expresses NK-1.1 and/or DX5. The majority (>50%) of T cells that express Ly-49 molecules also coexpress NK-1.1 and/or DX5, although some NK-1.1- and/or DX5-/CD3+ cells express Ly-49 molecules. Lysis of target cells by IL-2-cultured T cells expressing Ly-49A and G2 was enhanced by Abs specific for Ly-49A and G2 as well as by Abs to class I (H-2Dd alpha1/alpha2). Murine T cells also were cultured in the presence of targets that express (H-2Dd) which is inhibiting for the Ly-49A and G2 receptors. These cells were examined for a coincident increase in cytokine production (IFN-gamma, TNF-alpha, and granulocyte-macrophage CSF). Abs to Ly-49A and G2 or their respective class I ligands blocked the negative signals mediated via the Ly-49 receptors and increased IFN-gamma and granulocyte-macrophage CSF production after interaction of these T cells with H-2Dd-expressing tumor targets. Furthermore, an EL-4 T cell line expressing both Ly-49A and G2, when treated with mAb YE148 and 4D11, demonstrated reduced cytokine production and calcium mobilization. These results demonstrate for the first time that Ly-49 class I binding receptors, previously thought to be restricted to mouse NK cells, can mediate important physiological functions of T cell subsets.


Factors influencing augmentation and/or acceleration of lymphoreticular tumors in mice by benzo(a)pyrene treatment.
The response of lymphoreticular tissues to a single i.p. injection of benzo(a)pyrene was studied in the first generation of C57BL/6J X C3HeB/FeJ F1 and C3HeB/FeJ X A/J F1 mice. Groups of 1-, 15-, and 42-day-old animals of both sexes received 75 or 150 mug of the carcinogen per g body weight. After a period of approximately 90 weeks, a high incidence (up to 43%) of reticulum cell sarcomas was observed in C57BL/6J X C3HeB/FeJ F1 mice treated with benzo(a)pyrene at 40 days of age. Animals treated with carcinogen at younger ages had a lower incidence of reticulum cell sarcomas. These sarcomas showed marked cellular pleomorphism and were classified into histiocytic, epitheloid-nodular, reticulocytic, and fibrocytic forms according to the predominant cell type. Lymphomas of thymic and extrathymic lymphoid origin and leukemia of granulocytic type were seen in a descending order of frequency. Control animals of either strain that were killed at 90 weeks of age were basically free of lymphoreticular tumors, while those kept under observation up to 170 weeks developed these tumors in 24% (C57BL X C3H F1) and 10% (C3H X A/J F1), respectively. Studies revealed that the augmentation and/or acceleration of development of the lymphoreticular neoplasms and specifically reticulum cell sarcomas by benzo(a)pyrene was dependent upon the strain and sex of mice used and the age at which the animals were exposed to carcinogen.


The two P2 Ogr-like domains of the delta protein from bacteriophage P4 are required for activity.
The satellite P4 phage Delta protein positively regulates the late genes of its helper bacteriophage P2, as well as its own late genes. Delta is a member of a class of activators associated with P2-or P4-like phages and is the largest member of this family. It resembles a covalently joined head-to-tail dimer of the other members of this family of activators. We have analyzed the requirement for both standard domains of Delta through the isolation of amber mutants and the insertion of amber linkers. We show that both domains of Delta are required for DNA binding in vivo and for transcriptional activity. Proper spacing between the two domains is important for activity at two of the four P2 promoters. Expression of both domains from different plasmids causes activation of late gene transcription in vivo of all six late promoters of P2 and P4. A monomric Delta from another satellite phage, phi R73, can function efficiently as a covalent dimer but when this Delta is made dimeric with the second half of P4 delta, it activates less efficiently.


Cardiac tuberculosis: TB of the endocardium.
Tuberculosis involving the endocardium is extremely rare. The diagnosis is usually made during autopsy. Often there is involvement of other parts of the heart as well as other regions of the body. The infection is a result of direct extension from the myocardium or hematogenous spread. Two cases of disseminated tuberculosis with endocardial involvement are reported. In Case 1 miliary tuberculosis was diagnosed during life but the patient succumbed to extensive disease on the third hospital day. The patient in Case 2 presented with congestive cardiac failure and the possibility of tuberculosis was not suspected during life.


Haemonchus contortus: molecular characterisation of a small heat shock protein.
A cDNA encoding a predicted small heat shock protein, HSP20, was isolated from the parasitic nematode Haemonchus contortus. This cDNA encoded a predicted protein of 156 amino acids, which had high sequence identity with other nematode small heat shock proteins. Southern blot analysis of genomic DNA suggested that in H. contortus HSP20 is encoded by a single copy gene. The HSP20 transcript and protein were expressed in the infective larvae (L3), early L4 and adult stages, but expression was not increased by heat shock treatment. In situ hybridisation analysis was used to localise expression of HSP20 mRNA in the adult parasite. Similar HSPs (heat shock protein) were detected by Western blotting in Ancylostoma caninum, Dictyocaulus viviparus, and Toxocara canis, but not in Trichostronglyus colubriformis. The conservation of HSP20 in several different nematode species may reflect its importance to parasites that require mammalian hosts as a part of their development. Index Descriptors and Abbreviations: Haemonchus contortus; nematode; small heat shock protein; L3, infective larvae; xL3, exsheathed L3; eL4, early L4; EST, expressed sequence tag; HSP20, heat shock protein 20; sHSP, small heat shock protein


Immunoneutralization of endogenous glucagon reduces hepatic glucose output and improves long-term glycemic control in diabetic ob/ob mice.
In type 2 diabetes, glucagon levels are elevated in relation to the prevailing insulin and glucose levels. The relative hyperglucagonemia is linked to increased hepatic glucose output (HGO) and hyperglycemia. Antagonizing the effects of glucagon is therefore considered an attractive target for treatment of type 2 diabetes. In the current study, effects of eliminating glucagon signaling with a glucagon monoclonal antibody (mAb) were investigated in the diabetic ob/ob mouse. Acute effects of inhibiting glucagon action were studied by an oral glucose tolerance test (OGTT) and by measurement of HGO. In addition, the effects of subchronic (5 and 14 days) glucagon mAb treatment on plasma glucose, insulin, triglycerides, and HbA1c (A1C) levels were investigated. Glucagon mAb treatment reduced the area under the curve for glucose after an OGTT, reduced HGO, and increased the rate of hepatic glycogen synthesis. Glucagon mAb treatment for 5 days lowered plasma glucose and triglyceride levels, whereas 14 days of glucagon mAb treatment reduced A1C. In conclusion, acute and subchronic neutralization of endogenous glucagon improves glycemic control, thus supporting the contention that glucagon antagonism may represent a beneficial treatment of diabetes.


RGS4 and RGS5 are in vivo substrates of the N-end rule pathway.
The ATE1-encoded Arg-transferase mediates conjugation of Arg to N-terminal Asp, Glu, and Cys of certain eukaryotic proteins, yielding N-terminal Arg that can act as a degradation signal for the ubiquitin-dependent N-end rule pathway. We have previously shown that mouse ATE1-/- embryos die with defects in heart development and angiogenesis. Here, we report that the ATE1 Arg-transferase mediates the in vivo degradation of RGS4 and RGS5, which are negative regulators of specific G proteins whose functions include cardiac growth and angiogenesis. The proteolysis of these regulators of G protein signaling (RGS) proteins was perturbed either by hypoxia or in cells lacking ubiquitin ligases UBR1 and/or UBR2. Mutant RGS proteins in which the conserved Cys-2 residue could not become N-terminal were long-lived in vivo. We propose a model in which the sequential modifications of RGS4, RGS5, and RGS16 (N-terminal exposure of their Cys-2, its oxidation, and subsequent arginylation) act as a licensing mechanism in response to extracellular and intracellular signals before the targeting for proteolysis by UBR1 and UBR2. We also show that ATE1-/- embryos are impaired in the activation of extracellular signal-regulated kinase mitogen-activated protein kinases and in the expression of G protein-induced downstream effectors such as Jun, cyclin D1, and beta-myosin heavy chain. These results establish RGS4 and RGS5 as in vivo substrates of the mammalian N-end rule pathway and also suggest that the O2-ATE1-UBR1/UBR2 proteolytic circuit plays a role in RGS-regulated G protein signaling in the cardiovascular system.


Patient utilities in chronic musculoskeletal pain: how useful is the standard gamble method?
The main goal of current pain management approaches is to increase the patients' quality of life by improving pain coping skills and by reducing the levels of disability in daily life, often despite persistent pain. Direct measurement of quality of life is of crucial importance in economic evaluation research, in which not only is the estimation of financial costs and benefits included, but so is the evaluation of costs and benefits in terms of changes in health states. The purpose of this study is to compare the psychometric qualities of two instruments for assessing patients' utilities, the rating scale (RS) and the standard gamble (SG). Such instruments are designed for their application in economic evaluation research, but have seldomly been used in chronic pain trials. Both methods provide a single measure between 0 and 1. The relationship between these utility measures and descriptive and domain-specific quality of life measures was examined in 133 fibromyalgia patients and 148 patients with chronic non-specific low back pain. Mean utility score at baseline was 0.43 with the RS and 0.78 for the SG. The correlation between both methods was found to be poor (r = 0.21). Both measures appeared to be fairly stable in a 2-week test-retest period (intra class correlation coefficient (ICC) = 0.74 and 0.77). Scores on the description of patient's own health on six domains, global assessment of change and domain specific measures correlated moderately with the RS scores and low with the SG. Multiple regression analyses demonstrated that 32% of the variance in RS values and only 13% of the variance in SG utilities could be explained by domain-specific measures. These results suggest an acceptable construct validity for the RS but insufficient construct validity for the SG. Valuations of ones own health appear only partially to be related to the assessment of the pain-specific measures and measures of distress. It can be concluded that the RS and domain-specific measures assess partly different, but nevertheless complementary aspects of health-related quality of life. It is therefore recommended to include in economic evaluation studies both domain-specific measures and valuation measures. Finally, in chronic musculoskeletal pain patients, RS scores were found to be more responsive in detecting significant changes in preferences than SG scores. For use in patients with chronic musculoskeletal pain, the RS is preferred to the SG for establishing accurate decisions about the impact of new interventions on their health outcomes.


Art through the Colors of Graffiti: From the Perspective of the Chromatic Structure.
Graffiti is a general term that describes inscriptions on a wall, a practice with ancient origins, ranging from simple drawings and writings to elaborate pictorial representations. Nowadays, the term graffiti commonly describes the street art dedicated to wall paintings, which raises complex questions, including sociological, legal, political and aesthetic issues. Here we examine the aesthetics of graffiti colors by quantitatively characterizing and comparing their chromatic structure to that of traditional paintings in museums and natural scenes obtained by hyperspectral imaging. Two hundred twenty-eight photos of graffiti were taken in the city of São Paulo, Brazil. The colors of graffiti were represented in a color space and characterized by several statistical parameters. We found that graffiti have chromatic structures similar to those of traditional paintings, namely their preferred colors, distribution, and balance. In particular, they have color gamuts with the same degree of elongation, revealing a tendency for combining similar colors in the same proportions. Like more traditional artists, the preferred colors are close to the yellow-blue axis of color space, suggesting that graffiti artists' color choices also mimic those of the natural world. Even so, graffiti tend to have larger color gamuts due to the availability of a new generation of synthetic pigments, resulting in a greater freedom in color choice. A complementary analysis of graffiti from other countries supports the global generalization of these findings. By sharing their color structures with those of paintings, graffiti contribute to bringing art to the cities.


How do patients perceive support from nurses?
Patients found support in the clinical friendship of nurses. The nurses instilled a sense of normality into their activities, creating a supportive atmosphere. Patients expressed a need for reciprocity in their relationship with the nurses. This relationship should be balanced and sustainable.


A general strategy for the rational design of size-selective mesoporous catalysts.
A series of functionalized mesoporous silicas with cagelike pore topology has been synthesized and screened for size-selective catalytic transformations. The aluminum-catalyzed Meerwein-Ponndorf-Verley (MPV) reduction of differently sized aromatic aldehydes (benzaldehyde and 1-pyrenecarbox-aldehyde) has been investigated as a test reaction. The catalysts were synthesized in a two-step grafting sequence comprising pore-size engineering of mesoporous silicas (SBA-1, SBA-2, SBA-16) with long-chain alkyl dimethylaminosilanes and surface organoaluminum chemistry with triethylaluminum [{Al(CH(2)CH(3))3}2]. Size-selective reaction behavior was found for small pore SBA-1 materials, and the selectivity could be efficiently tuned by selecting a silylating reagent of appropriate size. The results are compared with the catalytic performance of a large-pore periodic mesoporous organosilica PMO[SBA-1] and the nonporous high-surface-area silicas Aerosil 300/380.


Statin use and cognitive function in middle-aged adults with type 1 diabetes.
To test associations between statin use and cognitive impairment in adults with childhood-onset type 1 diabetes (T1D). In 2010-13, n = 108 middle-aged participants from ongoing observational Pittsburgh Epidemiology of Diabetes Complications Study underwent neurocognitive assessment (mean age and T1D duration of 49 and 41 years, respectively). All were diagnosed with childhood-onset (i.e., prior to age 18) T1D between 1950 and 1980 and were seen within one year of diagnosis at Children's Hospital of Pittsburgh. Self-reported statin use (yes/no and if yes, name of statin) was collected biennially from parent study baseline (1986-1988) to time of neurocognitive testing. Logistic regression models tested associations between statin use groups and cognitive impairment (defined as having two or more cognitive test scores 1.5SD or worse than published norms) while linear regression models tested associations between statin use groups and cognitive domain z-scores (domains: Verbal IQ, memory, executive function, psychomotor speed, and visuo-construction). All models controlled for education and age. To address confounding by indication, models were repeated using a propensity score for statin use. Of the 108 participants, 51 reported never using statins. Median duration of statin use among the 57 ever users was 6 years. These 57 ever statin users were split to create two groups (≤ or > median years of statin use): 1-6 years (n = 25), and 7-12 years (n = 32). Compared with never users, using statins 1-6 years tripled the odds of cognitive impairment (OR = 3.16; 95%CI: 0.93-10.72; P = 0.06) and using statins 7-12 years almost quintupled the odds of cognitive impairment (OR = 4.84; 95%CI: 1.63-14.44; P = 0.005). Compared with never users, using statins 1-6 or 7-12 years was related to worse performance in the memory domain (β = -0.52; P = 0.003, and -0.39; P = 0.014, respectively). Adjusting for coronary artery disease, low density lipoprotein cholesterol, and Apo E4 status did not substantially alter results, and none of these covariates were significantly related to cognitive outcomes (all P > 0.05). Propensity score analyses support that associations between poor cognitive outcomes and statin use were not due merely to confounding by indication. Statin use was associated with cognitive impairment, particularly affecting memory, in these middle-aged adults with childhood-onset T1D, whom at this age, should not yet manifest age-related memory deficits.


Roles of NPAS2 in circadian rhythm and disease.
NPAS2, a circadian rhythm gene encoding the neuronal PAS domain protein 2 (NPAS2), has received widespread attention because of its complex functions in cells and diverse roles in disease progression, especially tumorigenesis. NPAS2 binds with DNA at E-box sequences and forms heterodimers with another circadian protein, brain and muscle ARNT-like protein 1 (BMAL1). Nucleotide variations of the NPAS2 gene have been shown to influence the overall survival and risk of death of cancer patients, and differential expression of NPAS2 has been linked to patient outcomes in breast cancer, lung cancer, non-Hodgkin's lymphoma, and other diseases. Here, we review the latest advances in our understanding of NPAS2 with the aim of drawing attention to its potential clinical applications and prospects.


Medicolegal implications of surgical errors and complications in neck surgery: A review based on the Italian current legislation.
Aim of the present paper is the review of the principal complications associated to endocrine neck surgery considering how expertise, full adoption of guidelines, appropriate technology and proper informed consent may limit the medicolegal claims at the light of the incoming new regulation of the medical professional legal responsibility. A literature search, using the Medline/PubMed database for full-length papers, was used. Postoperative recurrent laryngeal nerve (RLN) palsy and hypoparathy-roidism remain the principal causes of surgical malpractice claims . In the procedure of neck lymphadenctomy intra-operative haemorrhage, thoracic duct injury, injuries to loco-regional nerves can be observed and can be source of claims. After many years of increased medicolegal litigations, the Italian government is proposing a drastic change in the regulations of supposed medical malpractice in order to guarantee the patient's right to a safe treatment and in the meantime to defend clinicians from often unmotivated and prejudicial legal cases. Surgical errors and complications in neck surgery are a relevant clinical issue. Only the combination of surgical and clinical expertise, application of guidelines, appropriate technology and a routinely use of specific informed consent can contain potential medicolegal implications.


Genetic structure of Culex erraticus populations across the Americas.
Culex erraticus (Dyar & Knab) is a potential competent vector for several arboviruses such as Eastern and Venezuelan equine encephalitis viruses and West Nile virus. It therefore may play a role in the maintenance and spread of viral populations in areas of concern, including the United States where it occurs in >33 states. However, little information is available on potential barriers to movement across the species' distribution. Here, we analyze genetic variation among Cx. erraticus collected from Colombia, Guatemala, and nine locations in the United States to better understand population structure and connectivity. Comparative sequence analysis of the second internal transcribed spacer and mitochondrial NADH dehydrogenase genes identified two major lineages of sampled populations. One lineage represented the central and eastern United States, whereas the other corresponded to Central America, South America, and the western United States. Hierarchical analysis of genetic variation provided further evidence of regional population structure, although the majority of genetic variation was found to reside within populations, suggestive of large population sizes. Although significant physical barriers such as the Chihuahuan Desert probably constrain the spread of Cx. erraticus, large population sizes and connectivity within regions remain important risk factors that probably contribute to the movement of arboviruses within and between these regions.


What would pediatric infectious disease consultants recommend for management of culture-negative acute hematogenous osteomyelitis?
To assess the opinion of pediatric infectious disease (PID) specialists regarding the management of culture-negative acute hematogenous osteomyelitis. A questionnaire that included a hypothetical case scenario of a 4-year-old boy with culture-negative osteomyelitis was distributed via a Web-based system to PID specialists across the United States. Of 481 eligible participants surveyed, 147 (31%) responded. For initial therapy of osteomyelitis, 37% of respondents chose a beta-lactam, 24% chose clindamycin, 10% chose vancomycin as the sole therapy, and 29% chose a combination of these. The initial choice of antibiotics was correlated with the reported incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in the institution (P < 0.01). In areas where the prevalence of CA-MRSA was intermediate (between 25% and 50%), the choice of antibiotics was more heterogeneous. For change from intravenous to oral therapy, approximately 70% of respondents would change to oral therapy sooner than 3 weeks depending on clinical, laboratory, and social factors. After significant clinical and laboratory (sedimentation rate and C-reactive protein) improvements, most respondents (69%) chose to treat for a total duration (intravenous and oral) of 3 to 4 weeks. This study illustrates that the empiric choice of antibiotics for treatment of acute hematogenous osteomyelitis was driven by the local prevalence of CA-MRSA. When the prevalence of CA-MRSA was intermediate, the recommendations for management of bone infections were more heterogeneous. Clinical trials are needed to compare the effect of different management strategies on outcome, side effects, and costs. Level V.


Effect of fibrosarcoma induction on copper and ceruloplasmin concentration in different organs of the host.
The copper content and ceruloplasmin activity were determined in mice bearing benzo(a)pyrene induced fibrosarcoma. The copper level and ceruloplasmin activity in different organs of fibrosarcomatous mice varied when compared to their controls. Significant changes in copper and ceruloplasmin concentration were observed in the liver and tumor tissue of host mice bearing fibrosarcoma compared to controls. Disturbed copper metabolism at the hepatic level may account for the hypercupremia observed during malignancy.


Smokers' melanosis. Occurrence and localization in the attached gingiva.
The aim was to clinically study the frequency and extension of the melanin pigmentation in the attached gingiva and its relation to tobacco smoking. The population examined consisted of patients and dental nurse students at the School of Dentistry in Umeå, Sweden. All of the patients with pigmentation proved to be tobacco smokers. The pigmentation was given to name "smokers' melanosis.". Between 12.9% and 14.9% of those examined and between 25.5% and 31.0% of those who smoked had smokers' melanosis. Patients with smokers' melanosis had a significantly higher tobacco consumption than smokers without pigmentation. In 95.2%, smokers' melanosis was found in the mandible and was most common in the attached gingiva on the labial side of the canines and incisors. Smokers' melanosis is thus condidered to be caused by tobacco smoking and is expected to be found in other parts of the oral mucosa.


A shift in the optimum pH of pospholipase D produced by activating long-chain anions.
1. The activity of phospholipase D (phosphatidylcholine phosphatidohydrolase, EC 184.108.40.206) towards ultrasonically treated phosphatidylcholine or large phosphatidylcholine particles activated with ether was maximal near pH5, and there was little activity above pH6. 2. When the enzyme was activated by the addition of phosphatidic acid to large phosphatidylcholine particles the pH optimum was shifted to pH6.5 irrespective of the amount of activator added. 3. When the enzyme was activated with low concentrations of dodecyl sulphate the pH optimum was 5.5 with little activity above pH6. With higher concentrations of dodecyl sulphate the pH-activity profile was shifted upwards towards a pH optimum of 6.5-6.6, the magnitude of the shift depending on the extent of the hydrolysis. 4. The shifts in the pH-activity profiles cannot be correlated with changes in the ;surface pH' of the substrate particles calculated from the measurement of their zeta-potentials (electrophoretic mobilities).


[Complications of surgical resection of esophageal cancer].
Esophageal resection has undergone refinements over recent years, with improved outcomes. However, in-hospital mortality remains above 10% in developed countries and is below 5% in only a select group of hospitals. Morbidity remains high even in high-volume hospitals. We reviewed risk factors in esophageal resection. Pulmonary complications occur mainly in older patients and in those with pulmonary dysfunction, especially %FEV1 or hypoxia. Liver cirrhosis, squamous cell cancer, low patient volume, and cervical anastomoses also increase complication rates. Neoadjuvant chemoradiotherapy, which may be effective in squamous cell tumors, can also increase morbidity. The main cause of morbidity and mortality are pleuropulmonary complications. Also significant are anastomotic leak and esophageal conduit necrosis. A complex procedure such as esophageal resection is better served in specialized teams.


mdmx is a negative regulator of p53 activity in vivo.
Regulation of p53 protein activity is required for normal embryogenesis, tumor suppression, and cellular response to DNA damage. Here we report that loss of mdmx, a p53-binding protein, results in midgestational embryo lethality, a phenotype that is completely rescued by the absence of p53. Mice homozygous for both mdmx and p53 null mutations are viable and appear developmentally normal. Fibroblasts derived from embryos with reduced mdmx expression demonstrate a decreased growth rate and increased UV-induced apoptosis compared with wild-type cells and contain elevated levels of p53 and several p53 target proteins including the proapoptotic bax protein. These observations demonstrate that mdmx functions as a critical negative regulator of p53 in vivo.


Procedural sedation use in the ED: management of pediatric ear and nose foreign bodies.
This is the first report of which we are aware that describes the use of procedural sedation for the emergency department management of ear and nose foreign bodies in children < 18 years of age. During a 5.5-year period, we identified 312 cases of children with a foreign body in a single orifice (174 ear, 138 nose). Procedural sedation was performed in 23% of cases (43 ear, 28 nose) and ketamine was used most commonly (92%). Emergency physicians had a high rate of success in removing foreign bodies (84% ear, 95% nose) and a low complication rate. Procedural sedation had a positive effect on the success rate as more than half of the sedation cases had undergone failed attempts without sedation by the same physician. Emergency physicians should have familiarity with this indication for procedural sedation.


Analysis of clinical features and early warning signs in patients with severe COVID-19: A retrospective cohort study.
Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in December 2019. Although previous studies have described the clinical aspects of COVID-19, few studies have focused on the early detection of severe COVID-19. Therefore, this study aimed to identify the predictors of severe COVID-19 and to compare clinical features between patients with severe COVID-19 and those with less severe COVID-19. Patients admitted to designated hospital in the Henan Province of China who were either discharged or died prior to February 15, 2020 were enrolled retrospectively. Additionally, patients who underwent at least one of the following treatments were assigned to the severe group: continuous renal replacement therapy, high-flow oxygen absorption, noninvasive and invasive mechanical ventilation, or extracorporeal membrane oxygenation. The remaining patients were assigned to the non-severe group. Demographic information, initial symptoms, and first visit examination results were collected from the electronic medical records and compared between the groups. Multivariate logistic regression analysis was performed to determine the predictors of severe COVID-19. A receiver operating characteristic curve was used to identify a threshold for each predictor. Altogether,104 patients were enrolled in our study with 30 and 74 patients in the severe and non-severe groups, respectively. Multivariate logistic analysis indicated that patients aged ≥63 years (odds ratio = 41.0; 95% CI: 2.8, 592.4), with an absolute lymphocyte value of ≤1.02×109/L (odds ratio = 6.1; 95% CI = 1.5, 25.2) and a C-reactive protein level of ≥65.08mg/L (odds ratio = 8.9; 95% CI = 1.0, 74.2) were at a higher risk of severe illness. Thus, our results could be helpful in the early detection of patients at risk for severe illness, enabling the implementation of effective interventions and likely lowering the morbidity of COVID-19 patients.


Revisiting redundancy in hospitals-A case-based research study.
Redundancy is mostly conceived as "waste" resulting from inefficient operations that ought to be eliminated. However, there are scholars who challenge this view and argue that redundancy is an essential element in facilitating reliable and safe operations in health care delivery processes. The ambiguity on redundancy has led to limited insights in health care settings. This article seeks to provide clarity by investigating the conceptualization of redundancy within and across disparate contexts within hospital operations. An exploratory study using different hospital departments was conducted in two large hospitals as case studies to allow for in-depth understanding of the conceptualization of redundancy across hospital departments. Data sources included 42 semistructured interviews, surveys, field notes from site observations, and document analysis. The findings revealed alternative conceptualizations of redundancy, these being safety, care, heterogeneity, sustenance, and waste, and highlight their dominance in distinct hospital departments. The first four categories are positive in connotation, whereas the last, waste, has a negative connotation. Further, the analysis revealed that the conceptualization of redundancy is context dependent. Contrary to the general cognition of redundancy in the social science and management literature, our research found that redundancy might have a valuable role to play in core health care management concerns such as patient-centeredness, patient safety, and quality of care. This work is one of the first comprehensive studies on redundancy in the health care settings and is expected to steer scholarly conversations on redundancy in a more positive light. Overall, this article serves as a call to health care operations decision makers and chiefs of hospitals to reexamine their current approach and management practices on redundancy.


P53 codon 72 and HER2 codon 655 polymorphisms in Turkish breast cancer patients.
The polymorphisms in codon 72 of the tumor suppressor protein p53 (P53) gene and codon 655 of the human epidermal growth factor receptor 2 (HER2) gene have been suggested to play roles in most cancers. The purpose of this study was to investigate the association between common variants of HER-2 and P53 genes with breast cancer risk. Blood samples collected from 204 women with primary breast carcinoma and 192 healthy female controls were analyzed through polymerase chain reaction-restriction fragment length polymorphism methods. The frequencies of Arg/Arg, Arg/Pro, and Pro/Pro genotypes for P53 codon 72 were 51.7%, 41.4%, and 6.9% in patients and 42.6%, 47.3%, and 10.1% in controls, respectively. The frequencies of Ile/Ile, Ile/Val, and Val/Val genotypes for HER2 codon 655 were 75.0%, 22.5%, and 2.5% in patients and 73.4%, 25.0%, and 1.6% in controls, respectively. The genotype and allele frequencies between patient and control groups for P53 gene polymorphism were not significantly different (p = 0.177 and p = 0.07, respectively). Similarly, the genotype and allele frequencies between patient and control groups for HER2 gene polymorphism were not significantly different (p = 0.716 and p = 0.891, respectively). With the exception of association between the P53 codon 72 polymorphism and tumor stages (p = 0.026), there was no significant association between the studied polymorphisms and clinicopathological characteristics. The P53 gene codon 72 Arg/Pro and Her2 gene Ile655Val polymorphisms were not associated with the risk of breast cancer in Turkish women. However, significant associations between the P53 codon 72 and the homozygote and heterozygote Pro genotypes with tumor stages were found.


Quantitative Contact Resonance Force Microscopy for Viscoelastic Measurement of Soft Materials at the Solid-Liquid Interface.
Viscoelastic property measurements made at the solid-liquid interface are key to characterizing materials for a variety of biological and industrial applications. Further, nanostructured materials require nanoscale measurements. Here, material loss tangents (tan δ) were extracted from confounding liquid effects in nanoscale contact resonance force microscopy (CR-FM), an atomic force microscope based technique for observing mechanical properties of surfaces. Obtaining reliable CR-FM viscoelastic measurements in liquid is complicated by two effects. First, in liquid, spurious signals arise during cantilever excitation. Second, it is challenging to separate changes to cantilever behavior due to the sample from changes due to environmental damping and added mass effects. We overcame these challenges by applying photothermal cantilever excitation in multiple resonance modes and a predictive model for the hydrodynamic effects. We demonstrated quantitative, nanoscale viscoelastic CR-FM measurements of polymers at the solid-liquid interface. The technique is demonstrated on a point-by-point basis on polymer samples and while imaging in contact mode on a fixed plant cell wall. Values of tan δ for measurements made in water agreed with the values for measurements in air for some experimental conditions on polystyrene and for all examined conditions on polypropylene.


Role of complement in myasthenia gravis.
Myasthenia gravis is a prototypic neuroimmune disorder with autoantibodies targeting the acetylcholine receptor complex at the neuromuscular junction. Patients present with mainly ocular muscle weakness and tend to have a generalized muscle weakness later in the clinical course. The weakness can be severe and fatal when bulbar muscles are heavily involved. Acetylcholine receptor antibodies are present in the majority of patients and are of IgG1 and IgG3 subtypes which can activate the complement system. The complement involvement plays a major role in the neuromuscular junction damage and the supporting evidence in the literature is described in this article. Complement therapies were initially studied and approved for paroxysmal nocturnal hemoglobinuria and in the past decade, those have also been studied in myasthenia gravis. The currently available randomized control trial and real-world data on the efficacy and safety of the approved and investigational complement therapies are summarized in this review.


Catalyst-Controlled Stereoselective Barton-Kellogg Olefination.
Overcrowded alkenes are expeditiously prepared by the versatile Barton-Kellogg olefination and have remarkable applications as functional molecules owing to their unique stereochemical features. The induced stereodynamics thereby enable the controlled motion of molecular switches and motors, while the high configurational stability prevents undesired isomeric scrambling. Bistricyclic aromatic enes are prototypical overcrowded alkenes with outstanding stereochemical properties, but their stereocontrolled preparation was thus far only feasible in stereospecific reactions and with chiral auxiliaries. Herein we report that direct catalyst control is achieved by a stereoselective Barton-Kellogg olefination with enantio- and diastereocontrol for various bistricyclic aromatic enes. Using Rh2 (S-PTAD)4 as catalyst, several diazo compounds were selectively coupled with a thioketone to give one of the four anti-folded overcrowded alkene stereoisomers upon reduction. Complete stereodivergence was reached by catalyst control in combination with distinct thiirane reductions to provide all four stereoisomers with e.r. values of up to 99:1. We envision that this strategy will enable the synthesis of topologically unique overcrowded alkenes for functional materials, catalysis, energy- and electron transfer, and bioactive compounds.